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10.1245/ASO.2006.05.040
Annals of Surgical Oncology 13:843-850 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Prognostic Score in Gastric Cancer: The Importance of a Conjoint Analysis of Clinical, Pathologic, and Therapeutic Factors

Marcelo Leite Vieira Costa, MD, PhD, Karina de Cássia Braga Ribeiro, DDS, PhD, Marcel Autran César Machado, MD, PhD, Ana Carolina Leite Vieira Costa, MD and André Luis Montagnini, MD, PhD

Hospital do Câncer A.C. Camargo, Fundação Antônio Prudente, Professor Antônio Prudente Street 211, São Paulo, SP Brazil

Correspondence: Address correspondence and reprint requests to: Ana Carolina Leite Vieira Costa, MD; E-mail: anacaroltavora{at}hotmail.com.

Background: This study was designed to establish a prognostic score for gastric cancer that takes into account factors related to the tumor, the patient, and the treatment.

Methods: Two hundred thirty patients with gastric adenocarcinoma admitted to the Department of Abdominal Surgery at Hospital do Câncer A. C. Camargo (São Paulo) and treated by gastrectomy from January 1992 until December 1996 were included in this retrospective cohort. The prognostic score was created according to the variables identified in the multivariate analysis and by using the regression coefficients generated by the Cox regression.

Results: The 5-year overall survival rate was 44.5%. The final multivariate model identified six variables with a significant and independent effect on survival: sex, weight loss, lymphocyte count, tumor-node-metastasis staging, lymphadenectomy, and lymph node ratio. Patients were divided into four groups according to their scores, as follows: group 1, 0 to 3.0; group 2, 3.5 to 5.5; group 3, 6.0 to 8.5; and group 4, 9.0 to 14.0. The 5-year survival rates were 91.5%, 49.3%, 20.3%, and .0% for the score groups 1, 2, 3, and 4, respectively (P < .001). The score was superior in the assessment of prognosis when compared with tumor-node-metastasis staging alone.

Conclusions: It is possible to create a prognostic score that simultaneously includes factors related to the tumor, patient, and treatment, thus generating a more effective system in predicting the prognosis than the morphology-based staging systems.

Key Words: Stomach neoplasms • Prognosis • Neoplasm staging • Gastrectomy




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